Laparoscopic versus open extended radical left pancreatectomy for pancreatic ductal adenocarcinoma: an international propensity-score matched study.

Carcinoma, Pancreatic Ductal / surgery Humans Laparoscopy Pancreatectomy Pancreatic Neoplasms / surgery Retrospective Studies Treatment Outcome
ERLP Extended resection Left pancreatectomy PDAC

Journal

Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653

Informations de publication

Date de publication:
12 2021
Historique:
received: 06 10 2020
accepted: 02 12 2020
pubmed: 6 1 2021
medline: 6 1 2022
entrez: 5 1 2021
Statut: ppublish

Résumé

A radical left pancreatectomy in patients with pancreatic ductal adenocarcinoma (PDAC) may require extended, multivisceral resections. The role of a laparoscopic approach in extended radical left pancreatectomy (ERLP) is unclear since comparative studies are lacking. The aim of this study was to compare outcomes after laparoscopic vs open ERLP in patients with PDAC. An international multicenter propensity-score matched study including patients who underwent either laparoscopic or open ERLP (L-ERLP; O-ERLP) for PDAC was performed (2007-2015). The ISGPS definition for extended resection was used. Primary outcomes were overall survival, margin negative rate (R0), and lymph node retrieval. Between 2007 and 2015, 320 patients underwent ERLP in 34 centers from 12 countries (65 L-ERLP vs. 255 O-ERLP). After propensity-score matching, 44 L-ERLP could be matched to 44 O-ERLP. In the matched cohort, the conversion rate in L-ERLP group was 35%. The L-ERLP R0 resection rate (matched cohort) was comparable to O-ERLP (67% vs 48%; P = 0.063) but the lymph node yield was lower for L-ERLP than O-ERLP (median 11 vs 19, P = 0.023). L-ERLP was associated with less delayed gastric emptying (0% vs 16%, P = 0.006) and shorter hospital stay (median 9 vs 13 days, P = 0.005), as compared to O-ERLP. Outcomes were comparable for additional organ resections, vascular resections (besides splenic vessels), Clavien-Dindo grade ≥ III complications, or 90-day mortality (2% vs 2%, P = 0.973). The median overall survival was comparable between both groups (19 vs 20 months, P = 0.571). Conversion did not worsen outcomes in L-ERLP. The laparoscopic approach may be used safely in selected patients requiring ERLP for PDAC, since morbidity, mortality, and overall survival seem comparable, as compared to O-ERLP. L-ERLP is associated with a high conversion rate and reduced lymph node yield but also with less delayed gastric emptying and a shorter hospital stay, as compared to O-ERLP.

Sections du résumé

BACKGROUND
A radical left pancreatectomy in patients with pancreatic ductal adenocarcinoma (PDAC) may require extended, multivisceral resections. The role of a laparoscopic approach in extended radical left pancreatectomy (ERLP) is unclear since comparative studies are lacking. The aim of this study was to compare outcomes after laparoscopic vs open ERLP in patients with PDAC.
METHODS
An international multicenter propensity-score matched study including patients who underwent either laparoscopic or open ERLP (L-ERLP; O-ERLP) for PDAC was performed (2007-2015). The ISGPS definition for extended resection was used. Primary outcomes were overall survival, margin negative rate (R0), and lymph node retrieval.
RESULTS
Between 2007 and 2015, 320 patients underwent ERLP in 34 centers from 12 countries (65 L-ERLP vs. 255 O-ERLP). After propensity-score matching, 44 L-ERLP could be matched to 44 O-ERLP. In the matched cohort, the conversion rate in L-ERLP group was 35%. The L-ERLP R0 resection rate (matched cohort) was comparable to O-ERLP (67% vs 48%; P = 0.063) but the lymph node yield was lower for L-ERLP than O-ERLP (median 11 vs 19, P = 0.023). L-ERLP was associated with less delayed gastric emptying (0% vs 16%, P = 0.006) and shorter hospital stay (median 9 vs 13 days, P = 0.005), as compared to O-ERLP. Outcomes were comparable for additional organ resections, vascular resections (besides splenic vessels), Clavien-Dindo grade ≥ III complications, or 90-day mortality (2% vs 2%, P = 0.973). The median overall survival was comparable between both groups (19 vs 20 months, P = 0.571). Conversion did not worsen outcomes in L-ERLP.
CONCLUSION
The laparoscopic approach may be used safely in selected patients requiring ERLP for PDAC, since morbidity, mortality, and overall survival seem comparable, as compared to O-ERLP. L-ERLP is associated with a high conversion rate and reduced lymph node yield but also with less delayed gastric emptying and a shorter hospital stay, as compared to O-ERLP.

Identifiants

DOI: 10.1007/s00464-020-08206-y PMID: 33398565
pubmed: 33398565
doi: 10.1007/s00464-020-08206-y
pii: 10.1007/s00464-020-08206-y
doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

6949-6959

Informations de copyright

© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.

Références

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Auteurs

A Balduzzi (A)

Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands. alberto.balduzzi.bo@gmail.com.
General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. alberto.balduzzi.bo@gmail.com.
ORCID: 0000-0001-6018-8816

J van Hilst (J)

Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands.

M Korrel (M)

Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands.

S Lof (S)

Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands.
Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.

B Al-Sarireh (B)

Department of Surgery, Morriston Hospital, Swansea, UK.

A Alseidi (A)

Department of Surgery, Virginia Mason Medical Center, Seattle, USA.

F Berrevoet (F)

Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium.

B Björnsson (B)

Department of Surgery in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.

P van den Boezem (P)

Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.

U Boggi (U)

Department of Surgery, Universitá di Pisa, Pisa, Italy.

O R Busch (OR)

Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands.

G Butturini (G)

Department of Surgery, Pederzoli Hospital, Peschiera, Italy.

R Casadei (R)

Department of Surgery, S. Orsola-Malpighi Hospital, Bologna, Italy.

R van Dam (R)

Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Surgery, University Hospital RWTH Aachen, Aachen, Germany.

S Dokmak (S)

Department of Surgery, Hospital of Beaujon, Clichy, France.

B Edwin (B)

Department of Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway.

M A Sahakyan (MA)

Department of Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway.
Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia.

G Ercolani (G)

Department of General Surgery and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna Forlì, Forlì, Italy.
Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.

J M Fabre (JM)

Department of Surgery, Hopital Saint Eloi, Montpellier, France.

M Falconi (M)

San Raffaele Hospital Pancreas Translational & Clinical Research Center, San Raffaele Hospital, Università Vita-Salute, Milan, Italy.

A Forgione (A)

Department of Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.

B Gayet (B)

Department of Surgery, Institut Mutualiste Montsouris, Paris, France.

D Gomez (D)

Department of Surgery, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK.

B Groot Koerkamp (BG)

Department of Surgery, Erasmus MC, Rotterdam, The Netherlands.

T Hackert (T)

Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany.

T Keck (T)

Department of Surgery, University Hospital Schleswig-Holstein UKSH Campus Lübeck, Lübeck, Germany.

I Khatkov (I)

Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russian Federation.

C Krautz (C)

Department of Surgery, University Hospital Erlangen, Erlangen, Germany.

R Marudanayagam (R)

Department of Surgery, University Hospital Birmingham, Birmingham, UK.

K Menon (K)

Department of Surgery, King's College Hospital NHS Foundation Trust, London, UK.

A Pietrabissa (A)

Department of Surgery, University Hospital Pavia, Pavia, Italy.

I Poves (I)

Department of Surgery, Hospital del Mar, Barcelona, Spain.

A Sa Cunha (AS)

Department of Surgery, Hôpital Paul-Brousse, Villejuif, France.

R Salvia (R)

General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.

S Sánchez-Cabús (S)

Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain.

Z Soonawalla (Z)

Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK.

M Abu Hilal (MA)

Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK. abuhilal9@gmail.com.
Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy. abuhilal9@gmail.com.
HPB and Minimally Invasive Surgery, Southampton University, Southampton, UK. abuhilal9@gmail.com.

M G Besselink (MG)

Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands. m.g.besselink@amsterdamumc.nl.

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Classifications MeSH

questionsmedicales.fr › Maladies endocriniennes › Tumeurs des glandes endocrines › Tumeurs du pancréas › Carcinome du canal pancréatique › Laparoscopic versus open extended radical left...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Laparoscopic versus open extended radical left...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Endoscopie › Laparoscopie › Laparoscopic versus open extended radical left...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie digestive › Pancréatectomie › Laparoscopic versus open extended radical left...
questionsmedicales.fr › Maladies endocriniennes › Tumeurs des glandes endocrines › Tumeurs du pancréas › Laparoscopic versus open extended radical left...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Laparoscopic versus open extended radical left...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Laparoscopic versus open extended radical left...